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Ares Segura S. Los retos de la lactancia en un mundo complejo. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ares Segura S. The challenges of breastfeeding in a complex world. Anales de Pediatría (English Edition) 2022; 96:283-285. [DOI: 10.1016/j.anpede.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/26/2022] Open
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Ares Segura S, Casano-Sancho P, Chueca Guindulain M. [Assessment of thyroid function in the preterm and/or very low birth weight newborn]. An Pediatr (Barc) 2021; 95:S1695-4033(21)00172-7. [PMID: 33975810 DOI: 10.1016/j.anpedi.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/30/2021] [Accepted: 04/03/2021] [Indexed: 11/26/2022] Open
Abstract
The screening program or early detection of congenital hypothyroidism is one of the greatest advances achieved in Pediatrics. Thyroid hormones are essential for brain development and maturation, which continue into the neonatal stage. Alterations in thyroid function in premature and underweight children in the first months of life causes irreversible damage to the central nervous system and is one of the most frequent and avoidable causes of mental retardation. Diagnosis in the neonatal period is difficult, so it requires an analytical study to be able to carry out the appropriate treatment. The relevance of this problem justifies its communication to all areas of pediatrics. The main objective is to avoid brain damage in these patients. Other aspects to optimize the adequate development of these children with all the necessary periodic controls and to achieve the inclusion of the diagnosis of thyroid alterations during the stay in neonatal units and in the first months of life, need to implement the resources of the health centers and continue advancing according to current knowledge. In this document, we will focus on the screening of preterm newborns VLBW (<32 weeks of gestation) and/or very low weight for gestational age (1500-1000g VLBW or <1000g) and the function evaluation protocol thyroid in premature babies. We update the diagnostic procedures, the essential and complementary tests required, the etiology and the differential diagnoses in this pathology.
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Affiliation(s)
- Susana Ares Segura
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España.
| | - Paula Casano-Sancho
- Sección de Endocrinología Pediátrica, Institut de Recerca Pediàtrica, Hospital Sant Joan de Déu, Universidad de Barcelona, CIBER de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Barcelona, España
| | - María Chueca Guindulain
- Sección de Endocrinología Pediátrica, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
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Álvarez Aldeán J, Ares Segura S, Díaz González C, Montesdeoca Melián A, García Sánchez R, Boix Alonso H, Moreno-Pérez D. Recommendations for vaccination against ROTAvirus in PREMature newborns (ROTAPREM). Anales de Pediatría (English Edition) 2019. [DOI: 10.1016/j.anpede.2019.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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García-Ascaso MT, Ares Segura S, Ros Pérez P, Piñeiro Pérez R, Alfageme Zubillaga M. Thyroid Volume Assessment in 3-14 Year-Old Spanish Children from an Iodine-Replete Area. Eur Thyroid J 2019; 8:196-201. [PMID: 31602362 PMCID: PMC6738148 DOI: 10.1159/000499103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 02/21/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Few data exist on reference thyroid volumes (Tvols) for Spanish children. The standard tables of the World Health Organization (WHO) are only for children older than 6 years. The present cross-sectional study reports the normal Tvols of 3-14 year-old girls and boys living in Madrid (Spain). METHODS The study subjects were 217 children aged 3-14 years. Urinary iodine was determined, and, on the same day, cervical ultrasound examinations were performed by a single, experienced paediatric radiologist. The sex-specific, upper normal limits for Tvol were then determined, based on age and body surface area (BSA). RESULTS The median urinary iodine concentration was 120 µg/L (interquartile range 80-184); the population was therefore deemed to fall within the optimum range for iodine nutritional status. Eight children with heterogeneous glandular parenchyma were detected, as were 6 with increased vascularity, and 22 with intrathyroid cysts. Tvol increased with age and BSA in both sexes from the age of 3 years. In girls aged 11-12 years, Tvol was significantly larger than that in boys of the same age. When comparing children 6 years old and above, the 97th percentile Tvols with respect to gender/BSA were similar to WHO reference values, but by gender/age they were 30% larger. CONCLUSIONS This work proposes reference ultrasound-determined Tvols for 3-14-year-old children living in Madrid.
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Affiliation(s)
- Marta Taida García-Ascaso
- Servicio de Pediatría, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
- *Marta Taida García-Ascaso, Division of Pediatrics, Mount Sinai Hospital, 600 University Avenue, Toronto, ON M5G 1X5 (Canada), E-Mail
| | | | - Purificación Ros Pérez
- Servicio de Pediatría, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
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García Ascaso MT, Pérez PR, Alcol EC, López AL, de Lucas Collantes C, Santos IM, Tessier E, Segura SA. Nutritional status of iodine in children: When appropriateness relies on milk consumption and not adequate coverage of iodized salt in households. Clin Nutr ESPEN 2019; 30:52-58. [PMID: 30904229 DOI: 10.1016/j.clnesp.2019.02.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 12/05/2018] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND & AIMS Iodine deficiency inhibits the normal development of human beings and is the leading cause of preventable mental retardation. Our study aims to update the urinary iodine concentrations and the intake of iodized salt in children in Madrid (Spain). METHODS A cross-sectional study was designed where 217 children aged 3-14 years old were studied. A nutritional survey including the intake of iodized salt and other iodine-rich foods was performed. In addition, the urinary concentration of iodine was determined in each patient. RESULTS Near 60% of the surveyed households routinely used iodized salt. Significant differences in age, sex, country of birth, or country of birth and parents educational levels and iodized salt consumption were not found. The median of the urinary iodine level (120 μg/L; interquartile range 80-184) was significantly higher in boys than girls and more elevated in younger children. Iodized salt and milk consumption significantly increased the concentration of urinary iodine. Children who drank less than two glasses of milk per day and did not consume iodized salt have four times the risk of iodine deficiency compared to children who daily drank at least two glasses of milk and consumed iodized salt (P < 0.001). CONCLUSIONS The nutritional level of iodine in the children studied is appropriate despite the low consumption of iodized salt. This is due to the consumption of dairy products and milk. The younger the child, the better his/her iodine nutritional level. Teenagers studied are at higher risk of iodine deficiency.
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Affiliation(s)
| | - Purificación Ros Pérez
- Servicio de Pediatría, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Esmeralda Colino Alcol
- Servicio de Pediatría, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Agustín López López
- Servicio de Pediatría, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Isabel Millán Santos
- Servicio de Estadística, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - Elise Tessier
- London School of Hygiene and Tropical Medicine, London, UK
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Rodríguez Sánchez A, Chueca Guindulain MJ, Alija Merillas M, Ares Segura S, Moreno Navarro JC, Rodríguez Arnao MD. [Diagnosis and follow-up of patients with congenital hypothyroidism detected by neonatal screening]. An Pediatr (Barc) 2019; 90:250.e1-250.e8. [PMID: 30686624 DOI: 10.1016/j.anpedi.2018.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/05/2018] [Indexed: 11/26/2022] Open
Abstract
The screening program of congenital hypothyroidism (CH) is probably one of the best achievements in paediatrics. Thyroid hormones are essential for brain development and brain maturation that continue through the neonatal period. Hypothyroidism that begins in the first months of life causes irreversible damage to the central nervous system, and is one of the most frequent and preventable causes of mental retardation. As children with congenital hypothyroidism are born with a normal appearance, analytical studies are required to immediately start the appropriate therapy. This article analyses the aims, diagnostic procedures, tests required, aetiology, and differential diagnosis in this disorder. Especially relevant is to perform frequent monitoring to ensure dose adjustments of L-Thyroxine therapy, avoiding infra- or supra-dosing that negatively affects neurosensory functions. Re-evaluation of the aetiology permanent vs transient hypothyroidism is always recommended after 3years of chronological age. The relevance of this screening program should be widely discussed in paediatrics. The main objective is to avoid cerebral damage in these patients, and has been highly successful and economically beneficial. Other aspects are required to optimise patient outcomes, to perform all the controls according to the recommendations and to include, in the near future, the diagnosis of central hypothyroidism. Implementation of this program is necessary to progress in accordance with current scientific knowledge.
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Affiliation(s)
- Amparo Rodríguez Sánchez
- Sección de Endocrinología Pediátrica, Centro Clínico de Seguimiento de Endocrinopatías Congénitas, Comunidad Autónoma de Madrid, Hospital General Universitario Gregorio Marañón, Madrid, España
| | | | - María Alija Merillas
- Sección de Endocrinología Pediátrica, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Susana Ares Segura
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España.
| | | | - María Dolores Rodríguez Arnao
- Sección de Endocrinología Pediátrica, Centro Clínico de Seguimiento de Endocrinopatías Congénitas, Comunidad Autónoma de Madrid, Hospital General Universitario Gregorio Marañón, Madrid, España
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Ares Segura S, Temboury Molina C, Chueca Guindulain MJ, Grau Bolado G, Alija Merillas MJ, Caimari Jaume M, Casano Sancho P, Moreno Navarro JC, Rial Rodríguez JM, Rodríguez Sánchez A. Recommendations for the diagnosis and followup of the foetus and newborn child born to mothers with autoimmune thyroid disease. Anales de Pediatría (English Edition) 2018. [DOI: 10.1016/j.anpede.2018.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ares Segura S, Temboury Molina C, Chueca Guindulain MJ, Grau Bolado G, Alija Merillas MJ, Caimari Jaume M, Casano Sancho P, Moreno Navarro JC, Rial Rodríguez JM, Rodríguez Sánchez A. [Recommendations for the diagnosis and follow up of the foetus and newborn child born to mothers with autoimmune thyroid disease]. An Pediatr (Barc) 2018; 89:254.e1-254.e7. [PMID: 30177500 DOI: 10.1016/j.anpedi.2018.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/17/2018] [Accepted: 07/19/2018] [Indexed: 02/08/2023] Open
Abstract
The objective of this document is to review the current recommendations in the management of the foetus and the newborn child born to mothers with autoimmune thyroid disease. In 2017, the American Thyroid Association published guidelines for the diagnosis and management of thyroid disease during pregnancy and post-partum. In this guide, 97 recommendations were made, and an algorithm for the diagnosis and treatment of gestational hypothyroidism was proposed. Also, in this last year, a wide review was been published on the foetal and neonatal approach of the child of a mother with Graves' disease. The importance of the determination of maternal antibodies against thyrotropin receptor in the second half of pregnancy is stressed, in order to adequately stratify the risk in the neonate.
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Affiliation(s)
- Susana Ares Segura
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España.
| | | | | | - Gema Grau Bolado
- Endocrinología Infantil, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | | | - María Caimari Jaume
- Endocrinología Pediátrica, Hospital Universitario Son Espases, Palma de Mallorca, Baleares, España
| | - Paula Casano Sancho
- Sección de Endocrinología Pediátrica, Hospital Sant Joan de Déu , Barcelona, España
| | | | | | - Amparo Rodríguez Sánchez
- Unidad de Metabolismo y Desarrollo, Hospital General Universitario Gregorio Marañón , Madrid, España
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Ares Segura S, Arena Ansótegui J, Marta Díaz-Gómez N. The importance of maternal nutrition during breastfeeding: Do breastfeeding mothers need nutritional supplements? Anales de Pediatría (English Edition) 2016. [DOI: 10.1016/j.anpede.2015.07.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Ares Segura S, Arena Ansótegui J, Díaz-Gómez NM. La importancia de la nutrición materna durante la lactancia, ¿necesitan las madres lactantes suplementos nutricionales? An Pediatr (Barc) 2016; 84:347.e1-7. [DOI: 10.1016/j.anpedi.2015.07.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022] Open
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Temboury Molina MC, Rivero Martín MJ, de Juan Ruiz J, Ares Segura S. [Maternal autoimmune thyroid disease: relevance for the newborn]. Med Clin (Barc) 2014; 144:297-303. [PMID: 24486115 DOI: 10.1016/j.medcli.2013.10.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Revised: 10/26/2013] [Accepted: 10/31/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE Autoimmune thyroid disease is amongst the most frequent endocrine disorders during pregnancy. It is associated with an increase in perinatal morbidity, congenital defects, neurological damage, fetal and neonatal thyroid dysfunction. Maternal thyroid hormones play a key role in child neurodevelopment. We aimed to evaluate the thyroid function and the clinical course of neonates born from mothers with autoimmune thyroid disease during the first months of life in order to define the follow-up. PATIENTS AND METHOD We monitored thyroid function and clinical status during the first months in 81 newborns of mothers with autoimmune thyroid disease; 16 had Graves disease and 65 autoimmune thyroiditis. RESULTS A percentage of 4.93 newborns had congenital defects, and 8.64% neonates showed an increase in thyrotropin (TSH) (>9.5 μUI/mL 2 times) and required thyroxin within the first month of life. A 85.7% of these showed a negative newborn screening (due to a later increase of TSH). A higher TSH value in the newborn was related to an older age of the mother, higher levels of thyroid peroxidase (TPO) antibody during pregnancy and lower birth weight. A higher free thyroxine (FT4) value in the newborn was related to fewer days of life and mothers with Graves disease. CONCLUSIONS We recommend the evaluation of TSH, T4 and TPO antibodies before 10 weeks in all pregnant women with follow-up if maternal thyroid autoimmunity or disorders is detected. It is also recommended to test children's serum TSH and FT4 at 48 h of life in newborns of mothers with autoimmune thyroid disease and repeat them between the 2nd and 4th week in children with TSH>6 μUI/mL. Careful endocrine follow-up is advised in pregnant women and children if hyperthyroidism is detected.
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Affiliation(s)
| | | | - Jesús de Juan Ruiz
- Cátedra de Estadística, Escuela Superior de Ingenieros Industriales de Madrid, Madrid, España
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Fernández Ruiz A, García-Guereta L, Benito Bartolomé F, Burgueros M, Moreno F, del Cerro Marín MJ, Rubio Vidal MD, Ares Segura S, Gracia Bouthelier R. Alteraciones de la función tiroidea en niños con cardiopatía congénita tras la realización de cateterismo con contrastes yodados. Rev Esp Cardiol 2000. [DOI: 10.1016/s0300-8932(00)75122-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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